Comparison of the efficacy and safety of selective COX-2 inhibitors and non-steroidal anti-inflammatory drugs in the treatment of COVID-19 patients: a systematic review and network meta-analysis

The global epidemic of novel coronaviruses remains severe, and COX-2 selective inhibitors have attracted attention due to their promising clinical potential. Pertinent articles published up to 1 April 2025 were systematically searched and retrieved, including randomized controlled trials and cohort studies. To assess the efficacy of COX-2 selective inhibitors versus other NSAIDs, we analysed five aspects, including death, mechanical ventilation, ICU admission, oxygen uptake, and composite adverse effects. The results showed that COX-2 selective inhibitors significantly reduced the risk of death, with third-highest SUCRA ranking. Regarding the risk of mechanical ventilation, COX-2 inhibitors were associated with a reduced risk and ranked first according to SUCRA compared with other interventions. COX-2 inhibitors were also effective in reducing the risk of ICU admission and endotracheal intubation, again ranking first by SUCRA. In addition, COX-2 inhibitors demonstrated therapeutic potential in reducing the risk of composite adverse effects compared with other NSAIDs. Although this study shows that COX-2 inhibitors have good promise for the treatment of COVID-19, there is still a lack of high-quality RCTs to support the conclusions, and there is still room for improvement. (PROSPERO. CRD CRD42023445987) Not applicable.